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CARE COORD SPECIALIST- Duke Regional Hospital

Regular Full Time Durham, North Carolina
Requisition Number: 224172
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Duke Regional Hospital Duke Regional Hospital offers the personal touch and hometown feel of a community hospital while serving as an essential arm of internationally recognized Duke University Health System. Duke Regional has served Durham, Orange, Person, Granville and Alamance counties for more than 45 years. To be successful at caring for our community and have a strong reputation among patients who seek our care, we have 3,500 team members who work together to provide exceptional, compassionate and equitable healthcare 24/7. We are a place of learning and acceptance for team members just starting their careers, as well as an institution of family culture and professional development for employees who have served for decades in our hospital units.Duke Regional has 388 inpatient beds and offers a comprehensive range of medical, surgical and diagnostic services, including orthopedics, weight-loss surgery, women's services, and heart and vascular services. We also offer care at our Duke Rehabilitation Institute, Davis Ambulatory Surgical Center, Duke Ambulatory Surgery Center Arringdon, Health Services Center, and Duke Behavioral Health Center North Durham. In fiscal year 2021, Duke Regional Hospital admitted 16,422 patients, performed 18,152 surgeries and welcomed 2,673 babies into the world. U.S. News & World Report ranked Duke Regional Hospital as #9 in North Carolina and #4 in the Raleigh-Durham area for 2021-22. The Human Rights Campaign consistently names us a Healthcare Equality Leader, and we are a Joint Commission-accredited and Magnet-designated hospital.

Duke Regional Hospital is seeking to hire a Care Coordinator Specialist

Occ Summary

Perform a variety of specialized, complex activities in the coordination of the care needed for patient discharges and transitions of care. Strong emphasis on proactive problem resolution and departmenta lcommunications. Independently perform activities necessary to organize, maintain, and use electronic patient health records. Positions at this level have high customer service, strong analytic and problem solving skills, require interpretation and explanation of policy and external requirements related to, privacy, release of information, positive patient identity, and other department and organization-wide functions. Regular interaction required with case management staff, physician advisors, post-acute care providers, community based organizations, insurance companies, and governmental agencies. Detailed working knowledge and ability to apply HIPAA rules, North Carolina General Statutes, and other State and Federal laws regarding patient privacy. Detailed working knowledge and ability to apply State and Federal laws regarding discharge planning, Joint Commission requirements, and CMS guidelines and rules.

Hours:

40 hours a week meeting the needs of Duke Raleigh.

Occasional weekend requirements as needed.

Work Performed

Partners with Case Management team in arranging for discharge needs of patients including but not limited to durable medical equipment, home health, facility placement, dialysis, outpatient appointments, back transfers to outside hospitals, transportation, and home infusion. Performs a variety of specialized, complex activities in the coordination of post-acute care services. Reviews discharge planning forms for completeness, timing, and conformity to policy and guidelines. Delivers the Important Message from Medicare according to CMS guidelines to all indicated patients based on case manager’s noted expected discharge date. Participates in daily Case Management touchpoints with Case Managers, Social Workers, and Utilization Managers. Discusses referred cases, including, patient status, barriers to discharge, payer communication, expected discharge date, transition planning priorities, escalations and support needed. Reviews insurance coverage updates on all appropriate patients, asassigned. Regularly evaluates work list and re-prioritizes items for the day. Reviews requests for care coordination to identify dates of service, entity, provider and specific clinical documents needed to complete the requested referrals. Works extensively in the electronic health record to locate specific clinical documents for the purpose of fulfilling a request. Escalates more complex inquiries and barriers to the appropriate resource. Stays in close contact with the requester to alert Case Management Staff of barriers to completion of needed task, provide status updates and ultimately share details of case completion. Enters appropriate documentation of all discharge planning activities and communications according to department standard and closely monitors pending tasks and priority level of each task. Maintains strong working relationships with both internal Duke staff as well as external agency staff such as post-acute liaisons, admissions coordinators, medical providers and staff in community-based organizations to ensure timely, appropriate and safe transitions ofcare.Obtains all authorizations for SNF care, both byutilizing theNaviHealth portal for the payers who utilize that system as well as anyother processes use d by all other managed care and health plans. They will also use a similar system as NaviHealth utilized by the State to approve all post-acute care (including Home Health) for Medicaid beneficiaries covered by these commercial plans. Schedules peer-to-peer reviews for Physician Advisors (PAs) and communicate electronically to the PAs the dates/times and contact names/numbers of the payer's Medical Director with whom they will be speaking. Discusses rationale for initial denial of services with the PAs to assist in their preparation for the peer to peer discussion. Meticulous record keeping of this process will be expected as data will be needed to assess volume for future expansion. Develops, administers activities, monitors and evaluates programeffectiveness, and investigates trends. Advis es supervisor as to thestatus of current activities and additional or ex panded programrequirements. Provides input into appropriate program rec ommendationsor conclusions. Assists in developing and defining short and long termdepartmental specific goals and objectives. Implements decide d uponprogram adjustments. Coordinates projects and audits to improvepr ocesses related to Case Management efficiency of care coordination and discharge planning. Requires the ability to interpret and explain policy and external requirements related to, discharge planning, release of information, positive patient identity, and other department and organization-wide functions. Completes regular interaction, as indicated, with governmental agencies, providers of health care, insurance companies and auditing agencies. Possesses a detailed working knowledge and ability to apply HIPPA rules and other State and Federal laws regarding patient privacy. Possesses working knowledge of Joint Commission requirements and CMS guidelines and rules. Develops, coordinates and advises staff regarding relevant policies and guidelines. Educates and trains employees in proper methods and procedures to ensure efficient and accurate completion of work. Develops and provides job-specific training to new and existing employees within department.

Knowledge, Skills and Abilities

Good organizational skills, excellent investigative/analytic skills with detail orientation, and strong follow-through capabilities. Excellent verbal and written communication skills in order to effectively problem solve, develop working relationships and assist case managers, utilization managers and social workers. Must be able to meet deadlines, work independently, set priorities and maintain confidentiality. Ability to work calmly and efficiently in high-pressure situations Strong computer skills including word processing, spreadsheet development and completion and fluent in the use of electronic medical record. Must possess excellent written and verbal communication skills, and be skilled in team building and negotiation. Skilled in data analysis and application of data to operational processes.< /p>

Minimum Qualifications

Education

Associate's degree in business, healthcare administration, social work or a related healthcare. Bachelor's degree in business, healthcare administration, social work or a related healthcare field highly preferred.

Experience

2 years of related experience required A Bachelor's degree in a related field can substitute for the experience requirement.

Degrees, Licensures, Certifications

N/A

Duke is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.

Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas—an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.

Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essentialjob functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.

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